The information you give here is merely a formality and a means of keeping a private record of our supporters and to obtain a mailing address for your purchase.

You can type in the boxes and print this form off and include when posting cheque.
(You can move through the boxes by using your "TAB" key).

Your First Name

Your Surname

Use the box for any comments you may have:


My phone number is (please include your area code):


Your postal address:
(You must supply this for mailing)


Your email address:
(You must supply this for accreditation)


If you’re happy that your details are correct
please click "continue to payment".

Your help will be greatly appreciated.
Garry